1. Abiomed ELAB Meeting March 3, 2017
Ruth Fisher, MBA
Henry Ford Health System
Vice President
Heart and Vascular Services
Detroit, MI

2. Detroit Cardiogenic Shock Initiative

3. Detroit CSI What is Detroit CSI How did we start What are the results
Key factors for our success
How to start in your market

4. This is what people think Detroit looks like

5. This is what Detroit really looks like

6. What Detroit really looks like

7. Henry Ford Health System
Founded in 1915 by Henry Ford

8. Detroit CSI 5 competing hospitals systems
8 participating hospital locations

9. DETROIT CARDIOGENIC SHOCK INITIATIVE DETROIT CSI
Detroit Metro – 4.6M Population

10. What is Detroit CSI
Initiative led by cardiovascular leaders at 5 competing hospitals
Goal to reduce mortality in Cardiogenic shock patients
Developed new Shock treatment protocol
30 patient trial

11. How did we start? Visionary leader- 30 years in Detroit
Created a call to action
Partnered with Abiomed to help collect data
30 years in Detroit
Taught many of the CV leaders
Well known thought leader in acute PCI
Dr. William O’Neill, MD

12. Meeting of the families
We can do better
Quarterly meetings
“Leave your ego at the door”
Review current literature/data
Case discussion
Protocol refinement

13. Mortality after onset of Shock

14. Basir, Dixon, O’Neill et al. AJC. 2017
Early support leads to higher survival
Basir, Dixon, O’Neill et al. AJC. 2017

15. Fewer inotropes - higher survival rates
Basir, Dixon, O’Neill et al. AJC. 2017

16. Support first then PCI?

17. Protocol Hemodynamic support with device BEFORE PCI
“Door to Support Time” tracked
Measure cardiac output before and after
Reduce use of inotropes

19. Pilot Study July, 2016 – January, 2017 N = 30 Sites: Demographics
St Joseph's Pontiac (N=10)
Beaumont Royal Oak & Troy (N=9)
Henry Ford (N=6)
Detroit Medical Center (N=5)
Demographics
Age 63 +/- 13 years (36-87)
80% Male, 20% Female
Diabetics 48%

20. Pre-Procedural Characteristics
Transfer from outside hospital 31% (N=9/29)
4 patient transported with IABP
26% (N=8/30) In Hospital Cardiac Arrest
23% (N=7/30) Required CPR
67% presented to hospital in shock (N=19/28)

21. Procedural Characteristics
4 patients under active CPR at the time of Impella implantation
75% survival (N=3/4)
AMI to Shock Time (N=13)
93 minutes
100% Femoral Access
Shock to Device Time (N=23)
64.6 minutes (8-229)

22. Outcomes Cardiac Power 38% improvement in Cardiac Power Output
0.56 (Pre) (n=15)
0.90 (Post) (n=20)
38% improvement in Cardiac Power Output
38%
Out of 30 patients treated with new protocol 24 survived= 80% survival rate

23. Survival Rates Pre and Post Study

24. CARDIOGENIC SHOCK A CHANGE IN PARADIGM
DOOR TO BALLOON DOOR TO SUPPORT

25. News Conference Feb 8, 2017

26. News Conference

27. News Conference Detroit CSI team

28. Grateful patient 49 year old Dan Rolston Treated at Beaumont
Arrived in shock – flatlined
Beaumont cardiologist Ivan Hanson

29. News Conference
"This is exciting because for the first time in two decades, we've found a way to save lives" of cardiogenic shock patients, said Theodore Schreiber, M.D., president of the DMC Heart Hospital

30. Media Hits
Fox 2 TV
Top metro Detroit cardiologists team up to test new heart pump   
Detroit Free Press Newspaper
Detroit hospitals see hope for heart attacks with new pump
Crain’s Detroit Business Business News Magazine
Metro Detroit cardiologists work together to improve heart attack survival rates
Detroit News
Health systems: New heart attack treatment saving live
WWJ Radio
Critical Mention clip:
WDIV Radio
Cardiologists announce results of 'successful effort to save lives'
AP/Washington Times Newspaper
Cardiologists announce heart attack treatment initiative
WILX in Lansing TV

31. Key Factors to Success Competitors who were willing to collaborate
Visionary leader
Experienced and highly skilled interventionalists who were comfortable with the Impella device
Willing to share their data
Abiomed support

32. How to start a shock program
Determine level of experience and comfort with the Impella device in your market
Develop a “team”
Meeting of the “families”
Fellow
Acute PCI coordinator
CVAD registry / data coordinator
Institutional support
Hub and spoke model
Hospital/ cath lab/ administration
Education

33. Questions